Surgical Treatment of Shoulder Infection Following Rotator Cuff Repair

Background: Deep infection after rotator cuff repair (RCR) can cause significant morbidity and healthcare burden. Outcomes of surgical treatment of infection following RCR are limited. This study aimed to assess the clinical course and outcomes related to surgical management of deep infection following RCR. Methods: Patients treated with debridement for infection after RCR at a single institution were included. Postoperative deep infection included the following criteria: persistent drainage more than five days from index surgery, development of a sinus tract to the joint, >= 2 positive cultures at the time of revision surgery with the same bacteria, or presence of purulence. Functional outcomes (ASES, SANE, SF-12) were assessed at a minimum of 1-year post-debridement. Results: Twenty-three patients were included and analyzed at mean six years post-debridement. All were free of infection at the final follow-up. The average age was 55 years; fifteen (65.2%) had infection after primary RCR and eight (34.8%) after revision RCR. Twelve (52.2%) patients required a repeat debridement prior to eradicating infection for an average of 1.9 surgeries before clearance of infection. Statistically significant predictors of need for a repeat debridement included initial open RCR (P = .02), open debridement (P = .002) and infection requiring IV antibiotics (P = .014). Postoperative ASES, SANE, SF-12M, SF-12P, and satisfaction scores were 71.7 +/- 25.7, 67.0 +/- 28.1, 55.5 +/- 6.5, 38.4 +/- 14.3 and 3.7 +/- 1.3, respectively. Conclusion: Deep infection after RCR can be treated with open or arthroscopic debridement. However, more than 50% of patients may require multiple debridements. Final functional results after infection control following RCR are satisfactory. However, chronic infection predicts worse functional outcomes.